Presentation
Profound hyperuricemia was present in most patients. Transient hypercalcemia developed during the diuretic phase in 5 patients. One patient died. [annals.org]
The mean days of presentation was 7 days with a range 3-20 days. 25% of the patients presented early (within 4 days) the rest were all late presentations post-trauma. [jpma.org.pk]
BACKGROUND: Patients with traumatic rhabdomyolysis (crush syndrome)(CS) secondary to community beatings commonly present to a rural emergency department that has limited access to dialysis services. [ncbi.nlm.nih.gov]
If present it should be treated with fasciotomy. Fasciotomies should not be performed if the compartment syndrome has been present for > 24 hours. Open wounds should be treated with antibiotics, tetanus toxoid and debridement of necrotic tissue. [clinicaladvisor.com]
Musculoskeletal
- Myopathy
) muscular dystrophies and myopathies ( G71 - G72 ) myopathy in amyloidosis ( E85.- ) myopathy in polyarteritis nodosa ( M30.0 ) myopathy in rheumatoid arthritis ( M05.32 ) myopathy in scleroderma ( M34.- ) myopathy in Sjögren's syndrome ( M35.03 ) [icd10data.com]
Longer-term myalgias may be indicative of a metabolic myopathy, some nutritional deficiencies or chronic fatigue syndrome. [dbpedia.org]
It can be induced by numerous factors, including a crush injury to a limb, overuse of skeletal muscle, heat, alcoholism, viral infections, metabolic disorders, myopathies, drugs, toxins, and hypokalemia. [nejm.org]
Less common inherited causes of rhabdomyolysis include structural myopathies, channelopathies, and sickle-cell disease. [pubfacts.com]
- Muscle Swelling
Lethargy or coma was present in 17 patients and muscle swelling in 11. Evidence of rhabdomyolysis included markedly elevated creatine phosphokinase, myoglobinuria, and aldolase in blood. [annals.org]
Crush injury is compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances in the affected areas of the body, while crush syndrome is localized crush injury with systemic manifestations. [en.wikipedia.org]
Crush Injury: Compression of extremities or other parts of the body that causes muscle swelling and/or neurological disturbances. Crush Syndrome: Crush injury with systemic manifestations. [clinicaladvisor.com]
[…] soreness, and swelling Initiation of physical activity: foam rolling, dynamic warm-up, aquatic jogging, and stretching Phase 3: Activities Daily monitoring of hydration status, muscle soreness, and swelling Progression of physical activity: body-weight [physio-pedia.com]
Workup
Rhabdomyolysis: Differential Diagnoses and Workup. eMedicine 2009. ↑ Baxter R, Moore J. Diagnosis and Treatment of Acute Exertional Rhabdomyolysis. Journal of Orthopaedic and Sports Physical Therapy 2003; 33(3): 104-108 [physio-pedia.com]
Magnetic resonance imaging (MRI; assessment of myopathy) Other tests that may be considered include the following: Electrocardiography (ECG) Measurement of compartment pressures Muscle biopsy Immunoblotting, immunofluorescence, and genetic studies See Workup [emedicine.medscape.com]
Treatment
Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe. [ncbi.nlm.nih.gov]
Get clear, concise descriptions and evidence-based treatment guidelines for a full range of clinical conditions, ranging from the common to the unusual. [books.google.com]
Prognosis
The disease has good prognosis despite severe hypercatabolism and untreated profound hyperuricemia. FULL TEXT [annals.org]
OBJECTIVES: We assessed identification and management of these patients, considering: (i) early adverse parameters used to identify poor prognosis, (ii) the importance of early recognition, and (iii) appropriate management with aggressive fluid therapy [ncbi.nlm.nih.gov]
[…] described 4 : type 1 T1: homogeneously iso to hyperintense T2/STIR: homogeneously hyperintense T1 C+ (Gd): homogeneously enhancing type 2 T1: homogeneously/heterogeneously hyperintense T2: heterogeneously hyperintense T1 C+ (Gd): rim-enhancing Treatment and prognosis [radiopaedia.org]
The vital prognosis of post-traumatic crush injury was good but the sequelae of the compartment syndrome were major. The need for RRT was not linked to CPK levels but rather to acidosis due to intra-abdominal complications. [ccforum.biomedcentral.com]
Etiology
[…] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream. [eorif.com]
Topics for discussion • Background • Pathophysiology • Etiology • Prognosis • Clinical Features • Differential Diagnosis • Management 3. [slideshare.net]
The most common causes are muscle overextension, muscle compression and crush injury, but there are also numerous non-traumatic etiologies. The latter group can be broadly divided into toxic, infectious and metabolic causes. [news-medical.net]
The final common pathway in the cellular pathophysiology of rhabdomyolysis, regardless of etiology, is believed to be an impairment of either production or utilization of adenosine triphosphate (ATP). [ahcmedia.com]
Definition Etiology Causes of rhabdomyolysis Traumatic Crush injury Direct injury Nontraumatic Seizures Overexertion (e.g., ultramarathon) Intoxication (e.g., cocaine, heroin, alcohol, carbon monoxide, phencyclidine ) Skeletal muscle ischemia Infection [amboss.com]
Epidemiology
[…] synonyms: Rhabdomyolysis ICD-10 M62.82 - Rhabdomyolysis Rhabdomyolysis ICD-9 728.88 Rhabdomyolysis 728.88 Etiology / Epidemiology / Natural History muscle necrosis causing the release of myoglobin into the bloodstream. [eorif.com]
Angus' research, funded principally by the NIH, focuses on clinical, epidemiologic and translational studies of sepsis, pneumonia, and multisystem organ failure and on health services research of the organization and delivery of critical care services [books.google.com]
Prognostic and epidemiologic study, level III. Supplemental digital content is available in the text. [journals.lww.com]
Nonetheless, the genetic, epidemiological and biochemical features of coturnism have not yet been elucidated in full, and firm experimental data remain to be documented. [academic.oup.com]
Epidemiology Crush syndrome has been described in numerous settings, most commonly after earthquakes, during war and after explosions that have caused buildings to collapse. [patient.info]
Pathophysiology
The pathophysiology of rhabdomyolysis must be understood on cellular (microscopic) and muscle compartment (macroscopic) levels. [ahcmedia.com]
The pathophysiology of crush injury is not fully understood and no good animal model is known. Crush syndrome, which is the general manifestation of crush injury, is better understood. If not prevented, it will lead to acute renal failure. [ncbi.nlm.nih.gov]
Cirrhosis Controversial Indications Transfer to Specialized Centers Introduction Conclusion Alterations in Brain Metabolism and Use of Barbiturates Hypothermia Cerebral Perfusion Pressure and Neurointensive Care Treatment of PostTraumatic Brain Edema Pathophysiologic [books.google.com]
Seizures Overexertion (e.g., ultramarathon) Intoxication (e.g., cocaine, heroin, alcohol, carbon monoxide, phencyclidine ) Skeletal muscle ischemia Infection Adverse drug reactions (e.g., neuroleptics, statins ) Malignant hyperthermia References: [2] [3] Pathophysiology [amboss.com]
Prevention
Preventing the systemic and renal complications of the crush syndrome requires very early and vigorous treatment to sustain the circulation, preferably started at the site of the catastrophe. [ncbi.nlm.nih.gov]
It also prevents neutrophil adhesion and prevents secondary injury. It is directly bactericidal to anaerobic organisms. [clinicaladvisor.com]
See: reperfusion Patient care The goals of treatment are to prevent and treat renal dysfunction, reverse electrolyte abnormalities, and correct the underlying cause. [medical-dictionary.thefreedictionary.com]